Integrated management of post-remission leukaemia to optimise longevity and enhance quality of life: the improve longitudinal study.

Abstract

Introduction Intensive chemotherapy for newly diagnosed acute myeloid leukemia and acute lymphoblastic leukemia is associated with short and long-term treatment-related morbidity and mortality, resulting from patient, disease, and treatment factors. The toxicity of treatment is well appreciated, and there is now increasing interest in understanding the impact of therapy on physical, psychological, social and fnancial (PPSF) functioning. It is hypothesised that identifying impaired PPSF functioning will improve awareness and assist in early identification and intervention strategies to improve patient outcomes. Methods A multidisciplinary team collaborated to implement a longitudinal follow-up program. Patients aged >=18 years post completion of intensive therapy for acute leukaemia, achieved morphological remission and not proceeding to allogenic stem cell transplant in first remission, are eligible to participate. Patients are reviewed 3-monthly for 24 months in a dedicated IMPROVE clinic where there is systematic collection of patient-reported outcomes (including quality of life, fatigue, anxiety and depression; sleep quality; sexual function and fnancial toxicity); physical and ftness assessments, preventative health and pathology collection (including cytokine assessments). Results Recruitment commenced in February 2019 and is ongoing; to date 28 patients have consented to participate and 6 patients have withdrawn due to disease relapse. The COVID-19 pandemic significantly impacted recruitment and the reviews at planned timepoints. Despite this, many patients have completed multiple visits (>130 total visits to date) and had clinical fndings resulting in intervention. The clinic has been positively received with high retention rates. However, the current format is resource intensive and would be unsustainable for routine implementation. Conclusions Preliminary fndings indicate that a dedicated clinic assessing for PPSF functioning recognises issues not identifed in routine care. After data analysis, it is envisioned that the assessments deemed most benefcial will become incorporated as part of an ongoing survivorship clinic.